scholarly journals Upper Thoracic Spine Fractures Treated by Posterior Transpedicular Corpectomy, Expandable Cage and Fusion: Literature Review and Report of a Case of T4 Severe Burst Fracture

2014 ◽  
Vol 01 (02) ◽  
Author(s):  
Laura Gonzalez Garcia Jose AsoEscario
Keyword(s):  
Literature Review ◽  
Thoracic Spine ◽  
Burst Fracture ◽  
Spine Fractures ◽  
Upper Thoracic Spine ◽  
Expandable Cage ◽  
Thoracic Spine Fractures ◽  
Upper Thoracic

Diagnostic Imaging Pitfalls of Upper Thoracic Spine Fractures

Pain Medicine ◽  
2020 ◽  
Vol 21 (5) ◽  
pp. 1079-1081
Author(s):  
Aaron Conger ◽  
Christina Case ◽  
Zachary McCormick ◽  
Richard Kendall
Keyword(s):  
Diagnostic Imaging ◽  
Thoracic Spine ◽  
Spine Fractures ◽  
Upper Thoracic Spine ◽  
Thoracic Spine Fractures ◽  
Upper Thoracic ◽  
Imaging Pitfalls

Upper Thoracic Spine Fractures Outcomes and Complications in King Abdul-Aziz Medical City, Riyadh

2021 ◽  
pp. 16
Author(s):  
Faisal Konbaz
Keyword(s):  
Thoracic Spine ◽  
Sagittal Alignment ◽  
High Energy ◽  
Spine Fractures ◽  
Associated Injuries ◽  
Upper Thoracic Spine ◽  
Thoracic Spine Fractures ◽  
The Mean ◽  
Upper Thoracic ◽  
The Impact

Introduction: Upper thoracic spine fractures (T1-T6) are not uncommon. They are often high-energy injuries complicated by multiple life-threatening comorbidities. There is a controversial discussion in the literature regarding the treatment choices. Thoracic pedicle screw fixation has replaced all other fixation techniques for its success rate and safety. Despite the number of studies discussing upper thoracic spine fractures, data on literature reporting postoperative complications are deficient. The aim of the study was to assess, in a series of patients, the impact of traumatic upper thoracic fractures on sagittal alignment, the incidence of possible complications, and the effect of associated injuries. Methodology: This retrospective chart review study included all adult cases diagnosed as traumatic upper thoracic spine fractures in KAMC in Riyadh. Data were obtained from the computerized database. The information reviewed included fracture characteristics, associated injuries, pre- and postoperative neurological status and sagittal alignment, follow-up duration, and the presence of complications. Result: A total of 19 patients were included in the study. Of them, 17 (89.5%) were injured secondary to a motor vehicle accident. There were three patients with a fixation level crossing the CT junction, more blood loss and procedure time was noticed with these cases. There was a notable improvement in upper thoracic kyphosis by 9º when measuring pre- and postop fracture Cobb's angle. The mean preop angle was 28.98 and the mean postop was 20.76. Of all the 19 cases involved in the study, 3 patients had developed surgical site infection as a complication. No other complication was reviewed. Conclusion: It is well-known in the literature that the correction of kyphosis and the absence of residual deformity postoperatively are indicators of the success and safety of the procedure used. Our findings correspond to the literature discussion that the current practice in managing traumatic upper thoracic spine fracture in KAMC in Riyadh is relatively safe and effective. Yet, further studies are needed to elaborate more on the relationship between the presence of other injuries and patients’ factors and postoperative outcomes.

Clinical and radiographic outcomes of pedicle screw fixation for upper thoracic spine (T1–5) fractures: a retrospective cohort study of 27 cases

2009 ◽  
Vol 10 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Charles Fisher ◽  
Sandeep Singh ◽  
Michael Boyd ◽  
Stephen Kingwell ◽  
Brian Kwon ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Summary Score ◽  
Spine Fractures ◽  
Upper Thoracic Spine ◽  
Sf 36 ◽  
Health Related ◽  
Thoracic Spine Fractures ◽  
The Mean ◽  
Upper Thoracic

Object The use of pedicle screws (PSs) for stabilization of unstable thoracolumbar fractures has become the standard of care, but PS efficacy has not been reported in the upper thoracic spine. The primary outcome of this study was to determine the efficacy of PS fixation to achieve and maintain reduction of unstable upper thoracic spine fractures (T1–5). Secondary outcomes included scores on a 1-year postoperative generic health-related quality of life (QOL) questionnaire and postoperative complications. Methods This study was a retrospective analysis and cross-sectional outcome assessment of cases prospectively entered into a spine database from 1997 to 2004. All patients with a traumatic, unstable upper thoracic spine (T1–5) fracture who underwent PS fixation were included. Preoperative CT scans with sagittal plane reformatted images were used to determine kyphotic deformity and compared with immediate postoperative and latest follow-up radiographs or CT scans. Patient charts, operative notes, and the results of postoperative follow-up examinations were reviewed. Patients were mailed the Short Form-36v2 (SF-36 version 2) by an independent study coordinator. Results Cases involving 27 patients (23 male, 4 female) were evaluated. The patients' mean age was 39.9 years (range 16–73 years). In all, 251 PSs were passed between T-1 and T-8. The mean true kyphotic deformity was 18.2° preoperatively, 8.7° (p < 0.0005) initially postoperatively, and 10.1° at final follow-up (mean 2.3 years postoperatively). The mean SF-36 physical component summary score was 35.89 while the mental component summary score was 56.43 at a minimum of 1-year postoperatively (mean 3.2 years). There were no intraoperative vascular or neural complications. Conclusions In the hands of fellowship-trained spinal surgeons, PS fixation for reduction and stabilization of upper thoracic spine fractures is a safe and efficacious technique. Health-related QOL outcome data are deficient for spine trauma patients and should be an essential component of quantifying treatment outcomes.

scholarly journals Posterior 360-Degree Stabilisation of the Upper Thoracic Spine: A Technical Note

2007 ◽  
Vol 15 (2) ◽  
pp. 191-196 ◽  
Author(s):  
G Timbihurira ◽  
H Nakajima ◽  
S Kobayashi ◽  
R Sato ◽  
T Yayama ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Thoracic Spine ◽  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Burst Fracture ◽  
Technical Note ◽  
Vertebral Body Replacement ◽  
Upper Thoracic Spine ◽  
Pain Status ◽  
Upper Thoracic

Purpose. To describe a technique involving posterior 360-degree stabilisation of the upper thoracic spine: spinal cord decompression, posterior vertebral body replacement, and then posterior instrumentation and intercostal posterolateral vertebral stabilisation. Methods. Three men and 4 women aged 41 to 77 (mean, 58) years underwent posterior 360-degree stabilisation of the upper thoracic spine. Their indications for surgery were bone metastasis (n=5), burst fracture (n=1), and osteoporotic collapse with cord compression (n=1). Their clinical and radiological findings and treatment outcomes were retrospectively reviewed. Results. Pain status of all patients improved after surgery: 4 had severe and 3 had mild pain preoperatively; in 3 pain became minimal and 4 had none postoperatively. All patients except one had Frankel/American Spinal Injury Association scores of E after surgery indicating complete recovery of sensory and motor function. There were no complications related to surgery or instrumentation construct. At the time of review, one patient had died of old age 8.6 years after surgery and another from local recurrence and lung metastasis 5.7 years after surgery. All other patients were living. Conclusion. One-stage posterior 360-degree stabilisation and vertebral body replacement is a useful technique for upper thoracic spine surgery.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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